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FORM NU.ALSOW <br /> _ _ __ _ • SERVICE ORDER <br /> No. N 598112 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S.SANTA FE AVENUE ❑ COMPTON,CALIFORNIA 90221 ❑ (310) 886-3400 <br /> SAN DIEGO OFFICE NORTHERN CALIFORNIA <br /> 1-800-748-5744 EPA CAD028277036 1-800-727-2879 <br /> DATE /t " -7 ONETIME PICK UP DYES or XNO <br /> CUSTOMER ' S "'fir tC )-! `'t t RESIDENCE ❑ YES or jl`J NO <br /> ,r <br /> l �,/ <br /> BILLING ADDRESS CONTRACT CUSTOMER W YES or ❑ NO <br /> PLEASE PAY FROM THIS <br /> / SERVICE ORDER }} l <br /> PHONE X CONTACT CUSTOMER NUMBER 'r`.f� �' 74 <br /> r <br /> CUSTOMER EPA# 0((L r'L,'O 16 2— L� 1-t�n AMOUNT <br /> JOB SITE ADDRESS )"t -716 �j . /- ' .`fit L, . 9- CHECK NUMBER <br /> if )� ra ;.1:7J� P.O.NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUNT) <br /> 'OTES: COMMODITY / Cf <br /> HALIDES P.P.M. <br /> FI NON-RCRA HAZARDOUS WASTE, LIQUID(USED OIUMIXED OILS)STATE CODE 221 <br /> NO PLACARDS REQUIRED* <br /> ❑ NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)STATE CODE 133 <br /> *NO PLACARDS OR MARKINGS REQUIRED* NEXT SERVICE DATE <br /> ❑ OTHER DRUMS DRUM SIZE <br /> '3 <br /> MANIFEST NO. f ,r -70 <br /> f' )e. NO.OF GALLONS ry l! CJ <br /> DRIVER JY ( t 1 I y 4a. 1RUCK NO.&RT 31 / <br /> ❑ NONHAZARDOUS DRAINED USED OIL FILTER <br /> ❑ COMMERCIAL FILTER RECYCLING,33210 Western Avenue,Union City,CA,510-487-9277 <br /> ❑ ALTERNATE FACILITY <br /> DESIGNATED TSDF: ❑ ALVISO INDEPENDENT OIL-5002 Archer Street•Alviso,CA 95502•CAL000161743.(510)476-1740 <br /> ❑ BAYSIDE OIL 11,INC.•210 Encinal Street•Santa Cruz,CA 95060•CAD088838222•(408)427-3778 <br /> ❑ EVERGREEN ENV..4139 N.Valentine Ave. . Fresno,CA 93722.CAD982446882.(510)795-4400 <br /> ❑ DEMENNO/KERDOON •2000 N.Alameda Street•Compton,CA 90222•CAT080013352•(310)537-7100 <br /> X D/K DIXON.7300 Chevron Way.Dixon,CA 95620.CAT080012602.(707)693-6008 <br /> ❑ RAMOS ENVIRONMENTAL.1515 S.River Road .W.Sacramento,CA 95691.CAD044003556 .(916)371-5747 <br /> ❑ ASBURY ENVIRONMENTAL SERVICES•2549 Scott Avenue•Chico,CA 95928•CAL000827844 <br /> ❑ ALTERNATE FACILITY <br /> 'SD OIL,USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE This is to certify that the above named articles are properly classified, described, packaged, marked <br /> ''YCLED AT OUR SISTER COMPANY DEMENNO/KERDOON THE and labeled, and are in proper condition for transportation,according to the applicable regulations of <br /> .1GEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. the Department of Transportation. _ <br /> •1 HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY <br /> OTHER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 P.P.M.; X <br /> AND THAT THE WASTE DOES NOT CONTAIN ANY P.C.B'S.. CUSTOMER SIGNATURE DATE <br /> '1 FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL X <br /> DISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES, OR <br /> CONTAINS ANY P.C.B'S. PRINT NAME <br />